Persons with mental disorders account for a large and growing portion of Emergency Department (ED) visits in the United States. Because of the wide geographic distribution of EDs, telemedicine holds particular promise for increasing access and improving outcomes of mental health care. However, almost no existing research has examined the potential of telepsychiatry services as a means of treating mental health consumers seen in emergency departments. It is not clear if, or how, states might consider adopting these programs as a strategy for reaching this highly vulnerable population. In August 2008, South Carolina will begin implementing an ambitious plan titled, Partners in Behavioral Health Emergency Services (PBHES), designed to improve care for persons seen in its Emergency Departments statewide. The plan will implement a telepsychiatry consultation system in which psychiatrists will provide around-the-clock coverage for consultation with hospital emergency departments. The program will be rolled out to all emergency rooms in the State over a two-year period. This application proposes to build on a partnership between the South Carolina Department of Mental Health and Emory University to rigorously study the effectiveness, generalizability, and financial sustainability of this new initiative. Effectiveness will be studied by comparing access and quality of care for persons with mental illness following an emergency department visit to a set of matched controls. Generalizability will be assessed by examining the individual, the ED, and community-level moderators of the PBHES program's impact. Financial sustainability will be examined using a budget impact analysis from multiple state perspectives. Analyses will draw upon South Carolina's Data Warehouse, a unique, comprehensive, all-payer dataset that makes it possible to comprehensively track treatment contacts for individuals across the mental health, health, and social service systems. Additional analyses will compare outcomes for EDs in South Carolina to matched EDs in Georgia in order to account for potential contamination of the PBHES program in nonparticipating EDs, other unmeasured changes within the state, and censoring effects.